Ear-lobe crease as a marker of carotid artery arthrosclerosis.

therosclerosis is increasing among Japanese because of their changing lifestyle.1 Carotid ultrasound examination is a good non-invasive method of detecting atherosclerosis by measuring the intima–media thickness (IMT),2 plaque number (PN) and plaque score (PS).3 Atherosclerosis of the carotid artery is related with not only coronary artery disease (CAD),4,5 but also systemic atherosclerosis. However, in order to screen the high-risk subjects from the general population it is also important to consider cost performance in medical practice. Some body features that tend to indicate atherosclerosis have been found, such as central obesity,6 Achilles’ tendon thickness7 and xanthoma,8 and these are useful to identify subjects who have a high risk of atherosclerosis such as CAD. The ear-lobe crease (ELC) was first reported as an atherosclerosis risk factor in 1973, when it was reported by Frank.9 There have been several reports of the relationship between ELC and CAD. The ELC is useful as a risk factor of CAD, because it can be seen at a glance. When I read that paper approximately 25 years ago, I also became interested in this marker, but although I tried to evaluate the relationship between carotid atherosclerosis and the ELC in approximately 150 healthy individuals on an isolated island in the Seto Inland Sea, I could not prove the hypothesis. I concluded that the result was caused by the fact that it was a healthy population and that the ultrasound equipment at that time did not have a high enough resolution.